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Additional info for Last Minute Internal Medicine: A Concise Review for the Specialty Boards (Last Minute Series)
Determine 1-2 A&B V1 A II B Atrial traumatic inflammation and Atrial Flutter. (Reproduced, with permission, from Kasper DL, Braunwald, E, Fauci, AS, Hauser SL, Longo DL, Jameson, JL, & Isselbacher KJ, Eds. Harrison’s rules of inner drugs, sixteenth variation. determine 214-5, web page 1345. McGraw-Hill, Inc. , 2005. ) determine 1-3 Structural center illness definite No First selection variety IC LVEF <40% and/or CHF CAD general EF No CHF high blood pressure Amiodarone Dofetilide First offerings Sotalol Amiodarone First selection style IC moment offerings Sotalol Amiodarone moment offerings Amiodarone Dofetilide moment offerings Sotalol Amiodarone 3rd offerings variety IA Dofetilide 3rd selection sort IA 3rd offerings style IA Dofetilide thoughts for the choice of Antiarrythmic medicines to minimize the Recurrence of Atrial traumatic inflammation. (Reproduced, with permission, from Kasper DL, Braunwald, E, Fauci, AS, Hauser SL, Longo DL, Jameson, JL, & Isselbacher KJ, Eds. Harrison’s rules of inner drugs, sixteenth version. determine 214-6, web page 1346. McGraw-Hill, Inc. , 2005. ) 14 Table 1-17 Tachyarrhythmias ARRHYTHMIA ECG MECHANISM reviews 15 Atrio-ventricular (AV) nodal reentrant tachycardia (AVNRT) • usual, 160–180 bpm • Retrograde P wave often buried in QRS • twin pathways in AV node with discrepant conduction velocities and refractory sessions • center frequently structurally common • happens in all age teams, yet extra universal among 20 and forty years • extra universal in girls • Episodes extra common and lengthy in older sufferers Preexcitation syndromes (atrioventricular reentrant tachycardia resembling Wolff-ParkinsonWhite (WPW) syndrome) • such a lot with preexcitation obvious on ECG (delta wave, brief PR) • so much circumstances are slender advanced (orthodromic reentry with antegrade conduction down AV node) • accent pathway connecting atria to ventricle bypasses the AV node • frequently offers at more youthful a long time • elevated danger for atrial and ventricular ﬁbrillation therapy • Vagal maneuvers (Valsalva, ice water, carotid therapeutic massage) can terminate the arrhythmia in eighty% of instances • Adenosine if vagal maneuvers fail • BB or CCB can hinder recurrence • Antiarrhythmic type IC and III (not most well-liked therapy) • If refractory AVNRT or drug illiberal, think about healing catheter ablation • keep away from AV nodal blocking off brokers (BB, CCB) if extensive advanced • If slender advanced (orthodromic), ponder adenosine • Direct present (DC) cardioversion if volatile • If WPW with atrial ﬁbrillation contemplate ﬂecainide, amiodarone, procainamide, ibutilide, propafenone • contemplate healing radiofrequency ablation for drugresistant tachycardia in WPW, drug intolerance, or if sufferer has high-risk career (pilots and so forth) (continued) Table 1-17 Tachyarrhythmias (continued) ARRHYTHMIA ECG Atrial tachycardia • 150–250 bpm Multifocal atrial tachycardia (MAT) 100–130 bpm • not less than three varied P wave morphologies on ECG • 100–180 bpm • increased resting HR, exaggerated reaction to task irrelevant sinus tachycardia sixteen untimely atrial contractions (PAC) MECHANISM reviews therapy • might be because of reentry (most common), elevated automaticity, or brought on via job • kind of atrial tachycardia • Unknown mechanism • think about digoxin toxicity as a reason, in particular if AV block additionally current • frequently immune to drug remedy • BB, CCB, antiarrthmic classification Ia, Ic, and II • Ablation of atrial concentration healing • BB, CCB if tolerated • Antiarrhythmics useless • Older sufferers • give some thought to underlying COPD, theophylline use or CHF • typically impacts girls • Exclude secondary reasons • universal, benign • Exclude secondary explanations equivalent to atrial growth, strain elevation (HTN, valvular center disease), rigidity, or stimulants • give some thought to BB or CCB • administration of underlying pathology or avoidance of set off • If symptomatic and wish remedy, BB or CCB can be utilized bpm = beats in step with minute, HR = center fee; CHF = congestive center failure; COPD = continual obstructive pulmonary disorder; HTN = high blood pressure; AV = atrioventricular.